Early Alert Notification

The purpose of this form is to identify students who may be having academic or personal difficulties. We will follow up immediately with this student. In some cases this action will be direct, and in others it will be indirect. Thank you for bringing this to our attention so that we may assist this student in any way possible.

Your Information

I am:

Faculty

Staff

First Name: *

Last Name: *

Your email:

Student's Information

Name: *

ID #:

Course (if applicable):

Your Concerns

Emotionally:

Spiritually:

Academically:

Physically:

General Concerns:

Is experiencing financial challenges

Is seriously over-committed or stressed

Seems to lack sufficient academic ability

Is involved in a troubling situation

Has more chapel cuts than most students

Fails to keep appointments

Seems depressed or emotionally wrought

Fails to handle their responsibilities adequately

Shows disinterest, dissatisfaction, or lack of purpose

Shows lack of consideration of others

Demonstrates signs of being physically unhealthy

Seems to be struggling spiritually

Has not pre-registered

I have had contact with this student regarding my concerns: *

yes

no

Please keep my name confidential: *

yes

no

Follow-up: *

I would like to be notified of the follow-up action taken by Student Development staff.